Pelvic Organ Prolapse: Should I Have Surgery?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

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3

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Get the facts

Your options

Key points to remember

Many women have only mild symptoms of pelvic organ prolapse.
Surgery is usually done only when the prolapse affects your daily life and your
doctor thinks surgery will help.

Many kinds of surgery can be done for pelvic organ prolapse.
The type of surgery you have will depend on which organs have prolapsed.

Consider surgery if the prolapse is causing pain, if you are
having problems with your bladder and bowels, or if the prolapse is making it
hard for you to do activities you enjoy.

An organ can prolapse again after surgery. Surgery in one part
of your pelvis can make a prolapse in another part worse. This may mean that
you will need to have another surgery later.

You might be able to
relieve some symptoms on your own without surgery. You can do exercises at home
that make your pelvic muscles stronger.

If you choose, your doctor
can fit you with a device called a pessary. A pessary can help you cope with
pelvic organ prolapse. It's a removable device that fits in your vagina and
holds your pelvic organs in place.

Pelvic organ
prolapse occurs when a pelvic organ, such as your bladder, drops (prolapses)
from its normal spot in your lower belly and pushes against the sides of your
vagina. This can happen when the muscles that hold your pelvic organs in place
get weak or stretched from childbirth or surgery.

Many women with pelvic organ prolapse have only mild
symptoms. Surgery is usually done only when the prolapse is affecting your
daily life and your doctor thinks surgery will help. Consider surgery
if:

Many kinds of surgery can be done for pelvic organ
prolapse. The type of surgery you have will depend on which organs are
prolapsed.

Types of surgery include:

Repair of the vaginal wall (vaginal vault prolapse surgery).

Repair of the bladder (cystocele surgery) or urethra (urethrocele surgery).

Repair of the rectum (rectocele surgery) or small bowel (enterocele surgery).

Surgery to close the vagina (vaginal obliteration). This surgery is
only an option if you no longer want to have sexual intercourse.

Removal of the
uterus (hysterectomy).

During surgery for bladder, urethra, rectum, and small
bowel prolapse, the surgeon makes a cut, called an incision, in the wall of the
vagina. He or she pulls together the loose or torn tissue in the area of the
prolapsed organ and strengthens the wall of the vagina to keep the prolapse
from coming back.

During surgery for vaginal vault prolapse, the
surgeon makes an incision in the wall of the vagina. He or she attaches the top
of the vagina to the wall of the lower belly, to the spine in the lower back,
or to the
ligaments of the pelvis.

During a
hysterectomy, the surgeon removes the uterus.

During a vaginal
obliteration, the surgeon removes most of the vaginal lining and then sews the
vagina shut. If the woman still has her uterus, the doctor leaves a small
opening to allow fluid to drain from the uterus.

These surgeries
are usually done by a gynecologist or a urologist. You will have medicine
to make you sleepy during the surgery (anesthesia).
You may stay in the hospital for a day or two. You may go home with a catheter,
a flexible plastic tube that drains urine from your bladder when you can't
urinate by yourself.

After surgery, you will likely be able to
return to your normal activities in about 6 weeks.

For the first
3 months after surgery, you will need to take it easy and avoid heavy lifting
or long periods of standing. Your prolapse can return if you strain or lift too
soon after surgery.

It may be best to delay surgery if you plan
to have children. The strain of childbirth could cause your problem to come
back.

A hole or opening that forms between
two organs in your body, or between your body and your skin. This is called a
fistula.

Since surgery for pelvic organ prolapse is done to treat
symptoms caused by one prolapsed organ, you may still have other symptoms after
your surgery. Surgery in one part of your pelvis can make a prolapse in another
part worse. This may mean that you will need another surgery later.

Pelvic organ prolapse can come back after surgery. How well surgery works
depends on the type of surgery. But about 3 out of 10 women who
have the surgery end up having a second surgery.footnote 1 This means that about 7 out of 10
women don't have a second surgery.

The chances for success can be
higher when a woman has two surgical procedures during the same operation—one
to correct the prolapse and the other to help prevent incontinence problems
that can arise after surgery.footnote 2

Eat foods that are high in fiber to avoid constipation and
straining when you have a bowel movement.

Reach and stay at a
healthy weight, since more weight puts pressure on your pelvic muscles.

Avoid lifting heavy things that put stress on your pelvic
muscles.

If you choose, your doctor can have you fitted with a
device called a
pessary. A pessary can help you cope with pelvic organ
prolapse. It's a removable device that you put in your vagina. It holds the
pelvic organs in place. Pessaries can be useful if you don't want or can't have
surgery. Many women can control their symptoms for years by using a pessary.

You
may be fitted for a pessary by your doctor. A pessary is a device that holds
pelvic organs in place.

You have some pain
relief.

You have more control over your bladder and bowels with exercise
or a pessary.

You may still have
symptoms that affect your quality of life.

You may still need
surgery.

Personal stories about surgery for pelvic organ prolapse

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

My bladder
bulges, and I can feel it all the time. Sometimes it seems like it's going to
fall right out. It's uncomfortable and gets in the way when I play tennis or
run. I'm going to have the surgery.

Juanita, age 52

I didn't
know I had a medical problem until I had my yearly pelvic examination. I had some
discomfort, mostly pressure in my abdomen, but I didn't know what it was. It
doesn't bother me on a daily basis. My doctor gave me a sheet with some
exercises that I can do to make my pelvic muscles stronger. My symptoms aren't
a big problem for me right now. I'm going to wait and see what happens over
time.

Lettie, age
58

I've been trying to cope with this problem
for years. I've tried a lot of different things, even a pessary for a while.
But my condition isn't getting better. It might even be getting worse. I think
surgery could help me.

Marta, age 65

I have five
grown children and 12 grandchildren. I'm proud of how fit and active I am. My
biggest problem is that often I really have to urinate and I can't. I've found
ways to manage, though, by putting my fingers in my vagina and pressing on my
bladder. It's not the greatest solution but I think I'd like to keep on the way
I have for a while longer. Surgery is still an option for me, but I'm not going
to choose it now.

Carrie, age 60

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have surgery for pelvic organ prolapse

Reasons to manage symptoms for now without surgery

My symptoms are painful and embarrassing. I can't live with them.

My symptoms aren't that bad. They don't get in the way of my daily life.

More important

Equally important

More important

My condition makes it hard for me to enjoy sex.

My condition hasn't affected my sex life.

More important

Equally important

More important

The cost of surgery doesn't worry me.

I'm worried about how I would pay for the surgery.

More important

Equally important

More important

Resting and being less active for 3 months after surgery won't be a problem for me.

I can't rest and be less active for 3 months while I recover from surgery.

More important

Equally important

More important

I am done having children.

I still plan to have children.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Surgery

Managing symptoms without surgery

Leaning toward

Undecided

Leaning toward

What else do you need to make your decision?

Check the facts

1.1, I should have surgery only if the prolapse is affecting my daily life and my doctor thinks surgery will help.

TrueYou are right. Surgery is usually done only when the prolapse is affecting your daily life and your doctor thinks surgery will help.

FalseNo, this is not correct. Surgery is usually done only when the prolapse is affecting your daily life and your doctor thinks surgery will help.

I'm not sureIt may help to go back and read "Get the Facts." Surgery is usually done only when the prolapse is affecting your daily life and your doctor thinks surgery will help.

2.2, If I have surgery, it will relieve all my symptoms.

TrueNo, this is not correct. More than one pelvic organ can prolapse at a time. Surgery is done to treat symptoms caused by one prolapsed organ, so you may still have other symptoms after your surgery.

FalseYou are right. Surgery is done to treat symptoms caused by one prolapsed organ, so you may still have other symptoms after your surgery.

I'm not sureIt may help to go back and read "Get the Facts." Surgery won't be able to relieve all symptoms of pelvic organ prolapse.

3.3, Getting surgery is the only way to relieve my symptoms of pelvic organ prolapse.

TrueNo, that's wrong. You may be able to relieve some symptoms on your own. You can try exercises called Kegels to make your pelvic muscles stronger. Or you can ask your doctor about fitting you for a pessary.

FalseYou're right. You may be able to relieve some symptoms on your own. You can try exercises called Kegels to make your pelvic muscles stronger. Or you can ask your doctor about fitting you for a pessary.

I'm not sureIt may help to go back and read "Get the Facts." You may be able to relieve some symptoms of pelvic organ prolapse on your own, with special exercises or a pessary.

4.4, I may need to have surgery more than once for my pelvic organ prolapse.

TrueYou are right. About 3 out of 10 women who have the surgery end up having a second surgery.

FalseNo, that's wrong. Actually, about 3 out of 10 women who have the surgery end up having a second surgery.

I'm not sureIt may help to go back and read "Get the Facts." About 3 out of 10 women who have the surgery end up having a second surgery.

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Pelvic Organ Prolapse: Should I Have Surgery?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Get the facts

Compare your options

What matters most to you?

Where are you leaning now?

What else do you need to make your decision?

1. Get the Facts

Your options

Have surgery for pelvic organ prolapse.

Manage your symptoms for now without surgery.

Key points to remember

Many women have only mild symptoms of pelvic organ prolapse.
Surgery is usually done only when the prolapse affects your daily life and your
doctor thinks surgery will help.

Many kinds of surgery can be done for pelvic organ prolapse.
The type of surgery you have will depend on which organs have prolapsed.

Consider surgery if the prolapse is causing pain, if you are
having problems with your bladder and bowels, or if the prolapse is making it
hard for you to do activities you enjoy.

An organ can prolapse again after surgery. Surgery in one part
of your pelvis can make a prolapse in another part worse. This may mean that
you will need to have another surgery later.

You might be able to
relieve some symptoms on your own without surgery. You can do exercises at home
that make your pelvic muscles stronger.

If you choose, your doctor
can fit you with a device called a pessary. A pessary can help you cope with
pelvic organ prolapse. It's a removable device that fits in your vagina and
holds your pelvic organs in place.

FAQs

What is pelvic organ prolapse?

Pelvic organ
prolapse occurs when a pelvic organ, such as your bladder, drops (prolapses)
from its normal spot in your lower belly and pushes against the sides of your
vagina. This can happen when the muscles that hold your pelvic organs in place
get weak or stretched from childbirth or surgery.

Many women with pelvic organ prolapse have only mild
symptoms. Surgery is usually done only when the prolapse is affecting your
daily life and your doctor thinks surgery will help. Consider surgery
if:

The prolapse causes pain.

You
have problems with your bladder and bowels.

The prolapse makes it hard for you to do activities you
enjoy.

What kinds of surgery are done for pelvic organ prolapse?

Many kinds of surgery can be done for pelvic organ
prolapse. The type of surgery you have will depend on which organs are
prolapsed.

Types of surgery include:

Repair of the vaginal wall (vaginal vault prolapse surgery).

Repair of the bladder (cystocele surgery) or urethra (urethrocele surgery).

Repair of the rectum (rectocele surgery) or small bowel (enterocele surgery).

Surgery to close the vagina (vaginal obliteration). This surgery is
only an option if you no longer want to have sexual intercourse.

Removal of the
uterus (hysterectomy).

During surgery for bladder, urethra, rectum, and small
bowel prolapse, the surgeon makes a cut, called an incision, in the wall of the
vagina. He or she pulls together the loose or torn tissue in the area of the
prolapsed organ and strengthens the wall of the vagina to keep the prolapse
from coming back.

During surgery for vaginal vault prolapse, the
surgeon makes an incision in the wall of the vagina. He or she attaches the top
of the vagina to the wall of the lower belly, to the spine in the lower back,
or to the
ligaments of the pelvis.

During a
hysterectomy, the surgeon removes the uterus.

During a vaginal
obliteration, the surgeon removes most of the vaginal lining and then sews the
vagina shut. If the woman still has her uterus, the doctor leaves a small
opening to allow fluid to drain from the uterus.

These surgeries
are usually done by a gynecologist or a urologist. You will have medicine
to make you sleepy during the surgery (anesthesia).
You may stay in the hospital for a day or two. You may go home with a catheter,
a flexible plastic tube that drains urine from your bladder when you can't
urinate by yourself.

After surgery, you will likely be able to
return to your normal activities in about 6 weeks.

For the first
3 months after surgery, you will need to take it easy and avoid heavy lifting
or long periods of standing. Your prolapse can return if you strain or lift too
soon after surgery.

It may be best to delay surgery if you plan
to have children. The strain of childbirth could cause your problem to come
back.

What are the risks of surgery for pelvic organ prolapse?

Problems you may have after surgery can include:

Trouble controlling your bladder
(incontinence).

Not being able to empty your
bladder.

Pain during sex.

Infection.

Bladder injury.

A hole or opening that forms between
two organs in your body, or between your body and your skin. This is called a
fistula.

Since surgery for pelvic organ prolapse is done to treat
symptoms caused by one prolapsed organ, you may still have other symptoms after
your surgery. Surgery in one part of your pelvis can make a prolapse in another
part worse. This may mean that you will need another surgery later.

Pelvic organ prolapse can come back after surgery. How well surgery works
depends on the type of surgery. But about 3 out of 10 women who
have the surgery end up having a second surgery.1 This means that about 7 out of 10
women don't have a second surgery.

The chances for success can be
higher when a woman has two surgical procedures during the same operation—one
to correct the prolapse and the other to help prevent incontinence problems
that can arise after surgery.2

What are your other choices besides surgery?

You
may be able to relieve some symptoms of pelvic organ prolapse on your own.

Eat foods that are high in fiber to avoid constipation and
straining when you have a bowel movement.

Reach and stay at a
healthy weight, since more weight puts pressure on your pelvic muscles.

Avoid lifting heavy things that put stress on your pelvic
muscles.

If you choose, your doctor can have you fitted with a
device called a
pessary . A pessary can help you cope with pelvic organ
prolapse. It's a removable device that you put in your vagina. It holds the
pelvic organs in place. Pessaries can be useful if you don't want or can't have
surgery. Many women can control their symptoms for years by using a pessary.

Why might your doctor recommend surgery?

Your
doctor may encourage you to have surgery for pelvic organ prolapse if:

Your symptoms are painful or are affecting
your quality of life.

Nonsurgical treatments, such as using a pessary or special
exercises, have not helped.

2. Compare your options

Surgery for pelvic organ
prolapse

Managing your symptoms

What is usually involved?

You will probably stay in the hospital
for a day or two.

After surgery, you will likely be able to return to your normal
activities in about 6 weeks.

For the first 3 months after surgery,
you will need to get more rest and avoid heavy lifting or long periods of
standing.

You
may be fitted for a pessary by your doctor. A pessary is a device that holds
pelvic organs in place.

What are the benefits?

You have relief from
pain.

You have more control over your bladder and
bowels.

You have a better quality of life.

You have some pain
relief.

You have more control over your bladder and bowels with exercise
or a pessary.

What are the risks and side effects?

A pelvic organ prolapse
may come back after surgery.

If you have more than one prolapsed organ, you may still have
symptoms after surgery.

Surgery can leave you with other problems
such as incontinence, pain during sex, and bladder injury.

You may still have
symptoms that affect your quality of life.

You may still need
surgery.

Personal stories

Personal stories about surgery for pelvic organ prolapse

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"My bladder bulges, and I can feel it all the time. Sometimes it seems like it's going to fall right out. It's uncomfortable and gets in the way when I play tennis or run. I'm going to have the surgery."

— Juanita, age 52

"I didn't know I had a medical problem until I had my yearly pelvic examination. I had some discomfort, mostly pressure in my abdomen, but I didn't know what it was. It doesn't bother me on a daily basis. My doctor gave me a sheet with some exercises that I can do to make my pelvic muscles stronger. My symptoms aren't a big problem for me right now. I'm going to wait and see what happens over time."

— Lettie, age
58

"I've been trying to cope with this problem for years. I've tried a lot of different things, even a pessary for a while. But my condition isn't getting better. It might even be getting worse. I think surgery could help me."

— Marta, age 65

"I have five grown children and 12 grandchildren. I'm proud of how fit and active I am. My biggest problem is that often I really have to urinate and I can't. I've found ways to manage, though, by putting my fingers in my vagina and pressing on my bladder. It's not the greatest solution but I think I'd like to keep on the way I have for a while longer. Surgery is still an option for me, but I'm not going to choose it now."

— Carrie, age 60

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have surgery for pelvic organ prolapse

Reasons to manage symptoms for now without surgery

My symptoms are painful and embarrassing. I can't live with them.

My symptoms aren't that bad. They don't get in the way of my daily life.

More important

Equally important

More important

My condition makes it hard for me to enjoy sex.

My condition hasn't affected my sex life.

More important

Equally important

More important

The cost of surgery doesn't worry me.

I'm worried about how I would pay for the surgery.

More important

Equally important

More important

Resting and being less active for 3 months after surgery won't be a problem for me.

I can't rest and be less active for 3 months while I recover from surgery.

More important

Equally important

More important

I am done having children.

I still plan to have children.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Surgery

Managing symptoms without surgery

Leaning toward

Undecided

Leaning toward

5. What else do you need to make your decision?

Check the facts

1.
I should have surgery only if the prolapse is affecting my daily life and my doctor thinks surgery will help.

True

False

I'm not sure

You are right. Surgery is usually done only when the prolapse is affecting your daily life and your doctor thinks surgery will help.

2.
If I have surgery, it will relieve all my symptoms.

True

False

I'm not sure

You are right. Surgery is done to treat symptoms caused by one prolapsed organ, so you may still have other symptoms after your surgery.

3.
Getting surgery is the only way to relieve my symptoms of pelvic organ prolapse.

True

False

I'm not sure

You're right. You may be able to relieve some symptoms on your own. You can try exercises called Kegels to make your pelvic muscles stronger. Or you can ask your doctor about fitting you for a pessary.

4.
I may need to have surgery more than once for my pelvic organ prolapse.

True

False

I'm not sure

You are right. About 3 out of 10 women who have the surgery end up having a second surgery.

Decide what's next

1.
Do you understand the options available to you?

Yes

No

2.
Are you clear about which benefits and side effects matter most to you?

Yes

No

3.
Do you have enough support and advice from others to make a choice?

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